Impact of patient training patterns on peritonitis rates in a large national cohort study

Figueiredo, Ana Elizabeth; Moraes, Thyago Proença de; Bernardini, Judith; Poli-de-Figueiredo, Carlos Eduardo; Barretti, Pasqual; Olandoski, Márcia; Pecoits‐Filho, Roberto

doi:10.1093/ndt/gfu286

Cited by 60 publications

(52 citation statements)

References 24 publications

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“…According to previous reports published by The reported incidences of peritonitis were 0.60, 0.95, and 0.29 episodes per year in Australia and New Zealand [5], the Netherlands [6], and Brazil [7], respectively. From these reports, the incidence of peritonitis in Japan can be considered a relatively good result.…”

Section: Discussionmentioning

confidence: 87%

“…Recurrent peritonitis has a lower primary response rate to antibiotics, a lower complete cure rate, and a higher mortality rate compared with first peritonitis episodes and relapse peritonitis [17]. It was reported that the total training time and the timing of training for performance of PD are associated with the peritonitis incidence rate [7]. We need to consider methods to lower the incidence of recurrent and repeat peritonitis, including better analysis of etiology and improved individual patient retraining.…”

Section: Discussionmentioning

confidence: 99%

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Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

et al. 2016

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Background: Peritonitis is the main cause of withdrawal from peritoneal dialysis (PD) therapy in Japan. The precise extent of PD-associated peritonitis in Japan has not been investigated since 2005; we aimed to clarify the recent incidence and prognosis of PD peritonitis. Methods: The 248 institutional members of the Japanese Society for Peritoneal Dialysis were surveyed by questionnaire regarding peritonitis episodes during January 1 to December 31, 2013. Results: Replies from 114 members were received regarding 3042 PD patients, including 516 peritonitis patients, covering a total observation period of 31,686 patient months. The incidence of peritonitis in this study was 0.195 episodes per year. Detailed data on 544 peritonitis episodes in 466 patients was obtained. The causes, in ranked order, were unknown reason, contamination at peritoneal fluid exchange, and extension of intra-abdominal cavity infection. Effluent culture methods included using a blood culture bottle (50.9 %), large-volume culture (culturing sediment after centrifuging effluent) (31.7 %), and direct culture of effluent using a culture dish (12.7 %). The rank order of microbes identified in peritoneal effluent cultures was culture-negative, Streptococcus sp. and Staphylococcus aureus. Empiric therapy with two kinds of antibiotics was administered to 406 cases (75.2 %), most commonly cefazolin + ceftazidime. Antibiotic administration methods included intraperitoneal (51.4 %), intravenous (46.4 %), and oral (2.2 %). After a peritonitis episode, 461 patients (84.7 %) continued PD therapy, 80 (14.7 %) withdrew from PD treatment, and 6 (1.1 %) died. Prognosis among patients grouped by antibiotic administration method was statistically significantly different; in the oral administration group, the rates of mortality and catheter replacement were higher. Logistic regression analysis showed that catheter exit-site infection and frequency of past peritonitis episodes were independent factors associated with PD treatment withdrawal. Conclusions: Although the overall incidence of PD peritonitis in Japan was relatively low, several areas for future improvement were identified: unknown reason and culture-negative were the most frequently cited causes of peritonitis; 1.1 % of patients died, and 13.6 % discontinued PD therapy. Improvements in effluent culture techniques, antibiotic administration methods, etiology determination, and patient education could help. A more effective protocol must be established to further improve the treatment of PD peritonitis in Japan.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

et al. 2016

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“…More importantly, adequate dialysis care, including patient selection and training may be enough to offer patients adequate technique survival and risk of peritonitis, regardless of pre-dialysis care. Nevertheless, differences related to the pattern of training addressed to patients with and without pre-dialysis care may impact the time to first peritonitis outcome [16] .…”

Section: Discussionmentioning

confidence: 99%

Impact of Pre-Dialysis Care on Clinical Outcomes in Peritoneal Dialysis Patients

Spigolon

Figueiredo²,

Modesto

et al. 2016

Am J Nephrol

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Background: Structured pre-dialysis care is associated with an increase in peritoneal dialysis (PD) utilization, but not with peritonitis risk, technical and patient survival. This study aimed at analyzing the impact of pre-dialysis care on these outcomes. Methods: All incident patients starting PD between 2004 and 2011 in a Brazilian prospective cohort were included in this analysis. Patients were divided into 2 groups: early pre-dialysis care (90 days of follow-up by a nephrology team); and late pre-dialysis care (absent or less than 90 days follow-up). The socio-demographic, clinical and biochemical characteristics between the 2 groups were compared. Risk factors for the time to the first peritonitis episode, technique failure and mortality based on Cox proportional hazards models. Results: Four thousand one hundred seven patients were included. Patients with early pre-dialysis care presented differences in gender (female - 47.0 vs. 51.1%, p = 0.01); race (white - 63.8 vs. 71.7%, p < 0.01); education (<4 years - 61.9 vs. 71.0%, p < 0.01), respectively, compared to late care. Patients with early pre-dialysis care presented a higher prevalence of comorbidities, lower levels of creatinine, phosphorus, and glucose with a significantly better control of hemoglobin and potassium serum levels. There was no impact of pre-dialysis care on peritonitis rates (hazard ratio (HR) 0.88; 95% CI 0.77-1.01) and technique survival (HR 1.12; 95% CI 0.92-1.36). Patient survival (HR 1.20; 95% CI 1.03-1.41) was better in the early pre-dialysis care group. Conclusion: Earlier pre-dialysis care was associated with improved patient survival, but did not influence time to the first peritonitis nor technique survival in this national PD cohort.

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“…Only 4 were published in the last 12 months. Of these 1 article was a narrative review of the literature of educational interventions in PD which concluded that the topic remained an under-studied aspect of PD (2); another looked at the impact of training hours on infection and suggested a minimum of 15 hours training, to be done before catheter implantation or more than 10 days after (3), and the remaining 2 looked at preventing PD infections (4,5). One further observational study, by Firanek et al, analyzing best practices for nurse-led PD training programs for patients on automated peritoneal dialysis (APD) in the United States, stated that best practices 593 PDI NOVEMBER 2016 -VOL.…”

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confidence: 99%

A Syllabus for Teaching Peritoneal Dialysis to Patients and Caregivers

et al. 2016

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ISPD GUIDELINES/RECOMMENDATIONSBeing aware of controversies and lack of evidence in peritoneal dialysis (PD) training, the Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has undertaken a review of PD training programs around the world in order to develop a syllabus for PD training. This syllabus has been developed to help PD nurses train patients and caregivers based on a consensus of training program reviews, utilizing current theories and principles of adult education. It is designed as a 5-day program of about 3 hours per day, but both duration and content may be adjusted based on the learner. After completion of our proposed PD training syllabus, the PD nurse will have provided education to a patient and/or caregiver such that the patient/caregiver has the required knowledge, skills and abilities to perform PD at home safely and effectively. The course may also be modified to move some topics to additional training times in the early weeks after the initial sessions. Extra time may be needed to introduce other concepts, such as the renal diet or healthy lifestyle, or to arrange meetings with other healthcare professionals. The syllabus includes a checklist for PD patient assessment and another for PD training. Further research will be needed to evaluate the effect of training using this syllabus, based on patient and nurse satisfaction as well as on infection rates and longevity of PD as a treatment. . Based on the principles of adult learning, these guidelines established a broad description of a course and a set of proposals to aid the teacher/nurse (hereafter called the PD nurse). The committee currently believes that, while the recommendations are still relevant and agree with current teaching practices in PD clinics, there is a need for a more comprehensive course to guide PD nurses.The 2006 Guidelines tried to answer some questions that arise when talking about PD training: Who should be the trainer? Who is the learner? What should be taught? Where should the training occur? What should be the duration of training? How should the patient be taught? However, many of these questions remain unanswered. A search in PubMed using the words "training," "patient education," "peritoneal dialysis," and "peritonitis" found only 17 articles published in the last 5 years, and most of these were about infection prevention. Only 4 were published in the last 12 months. Of these 1 article was a narrative review of the literature of educational interventions in PD which concluded that the topic remained an under-studied aspect of PD (2); another looked at the impact of training hours on infection and suggested a minimum of 15 hours training, to be done before catheter implantation or more than 10 days after (3), and the remaining 2 looked at preventing PD infections (4,5). One further observational study, by Firanek et al., analyzing best practices for nurse-led PD training programs for patients on automated peritoneal dialysis (APD) in the United States, stated that best practices...

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Impact of patient training patterns on peritonitis rates in a large national cohort study

Cited by 60 publications

References 24 publications

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

Peritonitis in peritoneal dialysis patients in Japan: a 2013 retrospective questionnaire survey of Japanese Society for Peritoneal Dialysis member institutions

Impact of Pre-Dialysis Care on Clinical Outcomes in Peritoneal Dialysis Patients

A Syllabus for Teaching Peritoneal Dialysis to Patients and Caregivers

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